Regional Director of Case Management

Regional Director of Case Management & Clinical Reimbursement

As a Regional Director of Case Management, you will play a critical role in providing strategic leadership in the RAI process, care planning, compliance, and clinical reimbursement to maximize patient access to insurance benefits and ensure regulatory compliance.

Responsibilities:

• Provide education, support, and review of Medicare, Medicare Advantage, commercial insurance, and Medicaid cases to maximize reimbursement and maintain compliance.

• Collaborate with Regional Case Managers and facility teams to monitor processes and ensure appropriate follow-through.

• Provide guidance and support for facility Utilization Review meetings.

• Conduct analytical reviews of PDPM and RUGs reimbursement data to identify trends and opportunities for program development and operational

  improvement.

• Ability to respond quickly and effectively in emergency patient care situations.

• Oversee the hiring, onboarding, and ongoing education of Case Management nurses

• Provide continued training and support related to reimbursement, compliance, and case management processes

Qualifications:

• Must possess a degree in Nursing from an accredited school or be a graduate of an approved RN program.

• RAC certification preferred.

• Experience in a hospital, nursing care facility, or related healthcare facility.

• Working knowledge of Medicare, Medicaid, managed care programs, the RAI process, clinical reimbursement, and compliance regulations and guidelines.

• Experience using Microsoft Word, Excel, and electronic medical record (EMR) systems.

Benefits

• Medical, Dental, and Vision Insurance

• Paid Time Off (PTO)

• Paid Holidays

• Career Growth and Professional Development Opportunities

Apply Now:

If you are a motivated and experienced healthcare professional looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your application today to join our team.